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Biographical Data

We are an Equal Opportunity Employer. We consider all applications for all positions without regard to race, color, creed, religion, gender, national origin, age, sexual orientation, genetic predisposition, or carrier status, disability, martial status, pregnancy, arrest/conviction record, veteran status, domestic violence, victim status, or any other legally protected class or status. Please notify a company representative if you require a reasonable accommodation to participate in the application and/or interviewing process.

Reference 3

Have you ever been convicted of, and/or plead guilty to a felony or misdemeanor in the past seven years?*

If you answered ‘yes’ please provide additional information

Date of Offence

County and State in which Offense Occurred

Conviction/Explanation

Rehabilitation Completed

PLEASE READ CAREFULLY BELOW

I hereby certify that all of the information that I have provided on this Application for Employment Form is true and correct to the best of my knowledge. I understand that any misrepresentation of omission of facts will disqualify me from further consideration of employment, withdrawal of any offer of employment, or termination of employment if hired.

I authorize verification of all the information I have provided on this Application for Employment Form as well as any additional information needed to consider my application for employment. I further authorize all previous employers, educational institutions, references, and other persons who have knowledge of me or my records to provide any and all information pertinent to my employment and release the same from any liability resulting from providing such information. I also release this organization and all of its employees from all liability for any damage that may result from reliance on the information furnished.

The company is committed to providing a drug and alcohol-free workplace. After receiving a conditional offer of employment, I understand that a drug test will be required before starting work. If the results of the test are positive, I understand that the offer of employment will be withdrawn.

I understand that if employed, I am required to abide by all policies, procedures, rules and regulations of the organization. I also understand and agree that, if hired, my employment is “at-will” and is for no definite period, and may, regardless of the date of payment of my wages or salary, be terminated by myself or the company at any time without cause or notice.